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Evaluation of risk factors and outcomes of neonates with hypoxic ischemic encephalopathy and acute kidney injury

Journal of Perinatology volume 45, pages 1040–1046 (2025)Cite this article

Subjects

Abstract

Objectives

To assess risk factors for acute kidney injury (AKI) in neonates with hypoxic ischemic encephalopathy (HIE) using KDIGO and Gupta definitions, and evaluate long-term kidney function.

Methods

Retrospective study including 72 neonates with HIE and prospective evaluation of long-term kidney health data of 33 survivors.

Results

AKI was detected in 49% using KDIGO and 32% using Gupta’s definition. KDIGO-defined AKI correlated with thrombocytopenia, low pH, transfusions need, nephrotoxic drugs, and furosemide use (p < 0.05). The Gupta definition showed additional associations with hypotension, cardiac dysfunction, and death (p < 0.05). In a logistic regression model, both definitions linked AKI to nephrotoxic drug exposure and transfusions. Follow-up assessments revealed elevated blood pressure in 12%, hyperfiltration in 18%, and proteinuria in 6% of survivors.

Conclusions

The Gupta definition may help identify AKI in an additional number of neonates with HIE. Long-term monitoring is essential for the early detection of kidney dysfunction.

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Data availability

This article and its online supplementary material include all data generated or analyzed during the study. For further inquiries, the corresponding author may be contacted.

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Funding

The authors received a research grant from the Portuguese Society of Pediatrics (SPP) (“Bolsa de Investigação SPP”). The first author received a PhD grant from the CUF academic center (“Bolsa de Doutoramento em Medicina”).

Author information

Authors and Affiliations

  1. Neonatology Service, Pediatrics Department, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal

    Sara Todo Bom Costa & André Mendes Graça

  2. Hospital CUF Descobertas, Lisbon, Portugal

    Sara Todo Bom Costa

  3. Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Sara Todo Bom Costa, Patrícia Costa Reis & André Mendes Graça

  4. Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal

    Patrícia Costa Reis

Authors
  1. Sara Todo Bom Costa
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  2. Patrícia Costa Reis
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  3. André Mendes Graça
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Contributions

All authors participated in the study conception and design. The first author (SC) was responsible for data collection and analysis and prepared the draft manuscript. The second and third authors (PCR and AMG) reviewed the paper. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Sara Todo Bom Costa.

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Ethics

Study approval statement: This study protocol was reviewed and approved by the Centro Académico de Medicina de Lisboa (CAML) Ethics Committee. Consent to participate statement: A written informed consent was obtained from participants’ parents/legal guardians to participate in the study. All methods were performed in accordance with the relevant guidelines and regulations.

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The authors declare no competing interests.

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Todo Bom Costa, S., Costa Reis, P. & Mendes Graça, A. Evaluation of risk factors and outcomes of neonates with hypoxic ischemic encephalopathy and acute kidney injury. J Perinatol 45, 1040–1046 (2025). https://doi.org/10.1038/s41372-025-02379-x

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